Adaptive deep brain stimulation using movement desynchronization

Abstract

Techniques are disclosed for delivering electrical stimulation therapy to a patient. In one example, a medical system delivers electrical stimulation therapy to a tissue of the patient via electrodes. The medical system determines a first change of a first sensed signal of the patient to movement by the patient and a second change of a second sensed signal of the patient to the movement by the patient. Based on the first change and the second change, the medical system selects one of the first sensed signal and the second sensed signal of the patient for controlling the electrical stimulation therapy. The medical system adjusts a level of at least one parameter of the electrical stimulation therapy based on the selected one of the first sensed signal and the second sensed signal.

What is claimed is: 
     
         1 . An external programming device for adjusting electrical stimulation therapy delivered to a patient, the external programming device comprising:
 a user interface configured to display information related to delivery of the electrical stimulation therapy and to receive user input;   a telemetry module configured to communicate between the user interface and an implantable medical device implanted in the patient, wherein the implantable medical device is configured to deliver electrical stimulation therapy to a tissue of a patient via one or more electrodes;   a processor; and   a memory storing data for processing by the processor, the data, when processed, causing the processor to:
 receive a first user input from a clinician to define a first homeostatic window having an upper bound and a lower bound related to sensed response signals received during electrical stimulation therapy delivered to the tissue of the patient and a second therapeutic window having an upper bound and a lower bound related to a magnitude of at least one parameter of the electrical stimulation therapy, 
 receive a first sensed response signal of the patient during the delivery of the electrical stimulation therapy, 
 sense at least one of a posture and activity change associated with the patient, 
 adjust the magnitude of the at least one parameter of the electrical stimulation therapy based on the sensing the at least one of the posture and activity change associated with the patient, wherein the magnitude of the at least one parameter is at least one of incrementally increased or incrementally decreased within the second therapeutic window, 
 receive feedback corresponding to a feeling of paresthesia experienced by the patient in response to the electrical stimulation therapy, and 
 shift a position of the first homeostatic window based on the paresthesia feedback. 
   
     
     
         2 . The external programming device of  claim 1 , wherein the first sensed response signal is a plurality of sensed response signals, and wherein the memory stores additional instructions for execution by the at least one processor that, when executed, further cause the at least one processor to:
 receive patient input to readjust the magnitude of the at least one parameter when a second sensed response signal is at least one of less than the lower bound of the first homeostatic window or greater than the upper bound of the first homeostatic window.   
     
     
         3 . The external programming device of  claim 1 , wherein the at least one of the posture and activity change is sensed by the one or more electrodes proximate to a spine of the patient and wherein shifting the position of the first homeostatic window comprises adjusting both the upper bound and the lower bound of the first homeostatic window based on the paresthesia feedback. 
     
     
         4 . The external programming device of  claim 1 , wherein the electrical stimulation therapy is at least one of spinal cord stimulation therapy or deep brain stimulation therapy. 
     
     
         5 . The external programming device of  claim 1 , wherein the at least one parameter of the electrical stimulation therapy comprises at least one of a selection of one or more electrodes, a polarity of at least one electrode, a voltage amplitude, a current amplitude, a pulse width, and a pulse frequency. 
     
     
         6 . The external programming device of  claim 1 , wherein the user interface is configured to receive the user input via at least one of a keypad or a touch screen. 
     
     
         7 . The external programming device of  claim 1 , wherein the upper bound of the second therapeutic window comprises a maximum current amplitude. 
     
     
         8 . The external programming device of  claim 1 , wherein the at least one of the posture and activity change comprises the posture change. 
     
     
         9 . The external programming device of  claim 1 , wherein the telemetry module is configured to wirelessly communicate between the user interface and an implantable medical device. 
     
     
         10 . The external programming device of  claim 1 , wherein the movement of the patient causes a change in the magnitude of the first sensed response signal. 
     
     
         11 . The external programming device of  claim 1 , wherein the first sensed response signal is a plurality of sensed response signals, and wherein the memory stores additional instructions for execution by the at least one processor that, when executed, further cause the at least one processor to:
 receive a second sensed response signal of the patient during the delivery of the electrical stimulation therapy, and   determine a second magnitude of the second sensed response signal in response to a subsequent movement of the patient.   
     
     
         12 . The external programming device of  claim 1 , wherein the feedback is received via a second user input to the user interface. 
     
     
         13 . The external programming device of  claim 1 , wherein the upper bound or the lower bound of the first window are adjusted such that the magnitude of at least one parameter of the electrical stimulation therapy is aimed to prevent discomfort associated with the electrical stimulation therapy. 
     
     
         14 . A method for adjusting electrical stimulation therapy delivered to a patient comprising:
 receiving a first user input from a clinician to define a first window having an upper bound and a lower bound related to response signals received during electrical stimulation therapy delivered to tissue of the patient and a second window having an upper bound and a lower bound related to a magnitude of at least one parameter of the electrical stimulation therapy;   receiving a first response signal of the patient during the delivery of the electrical stimulation therapy;   sensing at least one of a posture and activity change associated with the patient;   adjusting the magnitude of the at least one parameter of the electrical stimulation therapy based on the sensing at least one of a posture and activity change associated with the patient, wherein the magnitude of the at least one parameter is at least one of incrementally increased or incrementally decreased within the second window;   receiving feedback corresponding to a feeling of paresthesia experienced by the patient in response to the electrical stimulation therapy; and   shifting a position of the first window based on the paresthesia feedback.   
     
     
         15 . The method of  claim 14 , wherein the at least one of the posture and activity change is sensed by one or more electrodes proximate to a spine of the patient and wherein shifting the position of the first window comprises adjusting both the upper bound and the lower bound of the first window based on the paresthesia feedback. 
     
     
         16 . The method of  claim 14 , wherein the electrical stimulation therapy is at least one of spinal cord stimulation therapy or deep brain stimulation therapy. 
     
     
         17 . The method of  claim 14 , wherein the first response signal is a plurality of response signals, and the method further comprises:
 receiving patient input to readjust the magnitude of the at least one parameter when a second response signal is at least one of less than the lower bound of the first window or greater than the upper bound of the first window.   
     
     
         18 . The method of  claim 14 , wherein the feedback is received via a second user input to a user interface. 
     
     
         19 . The method of  claim 14 , wherein the upper bound or the lower bound of the first window are adjusted such that the magnitude of at least one parameter of the electrical stimulation therapy is aimed to prevent discomfort associated with the electrical stimulation therapy. 
     
     
         20 . A system for adjusting electrical stimulation therapy delivered to a patient, the system comprising:
 an implantable medical device implanted in a patient and configured to deliver electrical stimulation therapy to a tissue of a patient via one or more electrodes;   an external programmable device having a user interface configured to display information related to delivery of the electrical stimulation therapy and to receive user input and a telemetry module configured to communicate between the user interface and the implantable medical device;   a processor; and   a memory storing data for processing by the processor, the data, when processed, causing the processor to:
 receive a first user input from a clinician to define a first window having an upper bound and a lower bound related to response signals received during electrical stimulation therapy delivered to the tissue of the patient and a second window having an upper bound and a lower bound related to a magnitude of at least one parameter of the electrical stimulation therapy, 
 receive a first response signal of the patient during the delivery of the electrical stimulation therapy, 
 sense at least one of a posture and activity change associated with the patient, 
 adjust the magnitude of the at least one parameter of the electrical stimulation therapy based on the sensing the at least one of the posture and activity change associated with the patient, wherein the magnitude of the at least one parameter is at least one of incrementally increased or incrementally decreased within the second window, 
 receive feedback corresponding to a feeling of paresthesia experienced by the patient in response to the electrical stimulation therapy, and 
 shift a position of the first window based on the paresthesia feedback. 
   
     
     
         21 . The system of  claim 20 , wherein the at least one of the posture and activity change is sensed by the one or more electrodes, which are proximate to a spine of the patient and wherein shifting the position of the first window comprises adjusting both the upper bound and the lower bound of the first window based on the paresthesia feedback. 
     
     
         22 . The system of  claim 20 , wherein the electrical stimulation therapy is at least one of spinal cord stimulation therapy or deep brain stimulation therapy. 
     
     
         23 . The system of  claim 20 , wherein the first response signal is a plurality of response signals, and wherein the memory stores additional instructions for execution by the at least one processor that, when executed, further cause the at least one processor to:
 receive patient input to readjust the magnitude of the at least one parameter when a second response signal is at least one of less than the lower bound of the first window or greater than the upper bound of the first window.   
     
     
         24 . The system of  claim 20 , wherein the feedback is received via a second user input to the user interface. 
     
     
         25 . The system of  claim 20 , wherein the upper bound or the lower bound of the first window are adjusted such that the magnitude of at least one parameter of the electrical stimulation therapy is aimed to prevent discomfort associated with the electrical stimulation therapy.